Chudner Irit, Shnider Avi, Gluzman Omer, Keidar Hadas, Haimi Motti
School of Behavioral Sciences, College of Management Academic Studies, Rishon LeZion 7570724, Israel.
Maccabi Healthcare Services, Tel Aviv 6801296, Israel.
Healthcare (Basel). 2024 Sep 2;12(17):1749. doi: 10.3390/healthcare12171749.
As primary care is an important infrastructure for the entire health system, the employment structure choices of family physicians-whether to work in a managed care organization or be self-employed, can impact all effectiveness parameters of healthcare: quality, access, health equity, patients' experiences, and cost-effectiveness. The aim of this study is to assess the push and pull factors influencing family physicians' employment choices.
This study employed a qualitative approach to explore the experiences of family physicians (FPs) who choose to work a self-employment practice. We conducted semi-structured interviews with twenty-seven self-employed FPs in Israel, selected through purposive and snowball sampling. The interviews were conducted via Zoom, recorded, and transcribed verbatim. Data analysis followed thematic analysis framework. The analysis yielded 10 themes, which were organized into two categories: pull and push factors.
Pull factors, i.e., factors that attract family physicians to become self-employed, included professional self-fulfillment, higher income, professional and business autonomy, working with secretaries according to one's personal choice, designing the space of the clinic, and flexibility in working hours. Push factors, i.e., factors that demotivated family physicians to work under managed care and pushed them to choose self-employment included low control over the work environment, workload, decreased professional and organizational autonomy, managerial pressures on quality measures, engagement in marketing activities, and tensions with non-medical staff in the Health Maintenance Organization.
There are obvious implications of this work for Health Maintenance Organizations' policy makers. Balancing managerial pressure and tensions between family physicians and non-medical administration and ensuring suitable working conditions increased physicians' control over the work environment, and professional autonomy may decrease push factors and retain family physicians as Health Maintenance Organization-employed. Understanding pull factors may help to develop a strategy for maximizing cooperation with self-employed family physicians and reinforce physicians' linkage to the healthcare system's treatment objectives.
由于初级保健是整个卫生系统的重要基础设施，家庭医生的就业结构选择——无论是在管理式医疗组织工作还是自主创业，都会影响医疗保健的所有有效性参数：质量、可及性、健康公平性、患者体验和成本效益。本研究的目的是评估影响家庭医生就业选择的推动因素和吸引因素。
本研究采用定性方法，探索选择自主执业的家庭医生的经历。我们通过目的抽样和滚雪球抽样，对以色列的27名自主执业的家庭医生进行了半结构化访谈。访谈通过Zoom进行，录音并逐字转录。数据分析遵循主题分析框架。分析得出10个主题，分为两类：吸引因素和推动因素。
吸引因素即吸引家庭医生自主创业的因素，包括职业成就感、更高的收入、职业和商业自主权、根据个人选择与秘书合作、设计诊所空间以及工作时间灵活性。推动因素即促使家庭医生不愿在管理式医疗下工作并促使他们选择自主创业的因素，包括对工作环境的控制低、工作量、专业和组织自主权降低、质量指标的管理压力、参与营销活动以及与健康维护组织中非医疗人员的紧张关系。
这项工作对健康维护组织的政策制定者有明显影响。平衡管理压力以及家庭医生与非医疗管理人员之间的紧张关系，并确保合适的工作条件以增加医生对工作环境的控制，专业自主权可能会减少推动因素，并留住作为健康维护组织雇员的家庭医生。了解吸引因素可能有助于制定一项战略，以最大限度地与自主执业的家庭医生合作，并加强医生与医疗系统治疗目标的联系。
